As the healthcare industry moves into 2025, pediatricians and medical coders face a fresh set of challenges with updates to the CPT codes. While keeping up with CPT codes can be overwhelming, staying informed about the new coding guidelines is key to maintaining an efficient workflow and seamless care in pediatric practices. The 2025 revisions to CPT codes introduce important modifications specific to pediatric specialty, enhancing the accuracy of coding and billing practices for pediatric services. To navigate these changes effectively, pediatric practices can benefit from outsourcing medical coding and billing services. Partnering with a skilled team of professionals ensures that pediatric practices remain compliant with the latest coding updates, reduce billing errors, and improve reimbursement rates.
Key Pediatric CPT Codes Update in 2025
The American Medical Association (AMA) has released 420 updates in the CPT 2025 code set, including 270 new codes, 112 deletions, and 38 revisions. The key changes for pediatric coding include new codes for telemedicine, pediatric vaccine, and remote therapeutic monitoring. The new telemedicine codes aim to improve the accuracy of reporting remote pediatric services and ensure appropriate reimbursement. These include codes for both audio-video and audio-only telehealth encounters, as well as a new code for brief virtual check-ins.
Additionally, remote therapeutic monitoring codes (98975-98978) have been introduced or revised, allowing pediatric providers to report services related to remote monitoring of chronic conditions and mental health therapy. These updates aim to reflect the evolving healthcare needs of children and aim to enhance the accuracy and efficiency of pediatric coding practices.
Let’s review the primary pediatric CPT code updates in 2025:
- New Telemedicine Codes
A significant change for CPT codes in 2025 is the introduction of new telemedicine codes to more accurately capture the delivery of remote pediatric services. These codes aim to enhance the reporting of telehealth services provided to pediatric patients, ensuring appropriate reimbursement for pediatric care. The new codes include:
CPT codes for reporting new patients in audio-video telecommunications:
- 98000 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
- 98001 – …which requires a medically appropriate history and/or examination and low medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
- 98002 – …which requires a medically appropriate history and/or examination and moderate medical decision-making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
- 98003 – which requires a medically appropriate history and/or examination and high medical decision-making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
For Established Patients
- 98004 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
- 98005 – … which requires a medically appropriate history and/or examination and low medical decision-making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
- 98006 – …which requires a medically appropriate history and/or examination and moderate medical decision-making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
- 98007 – … which requires a medically appropriate history and/or examination and high medical decision-making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
CPT codes for reporting new patients audio-only telecommunication visits:
- 98008 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves straightforward medical decision making, and/or the provider spends 15 or more minutes of total time on the encounter on a single date.
- 98009 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves low medical decision making, and/or the provider spends 30 or more minutes of total time on the encounter on a single date.
- 98010 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves moderate medical decision making, and/or the provider spends 45 or more minutes of total time on the encounter on a single date.
- 98011 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves high medical decision making, and/or the provider spends 60 or more minutes of total time on the encounter on a single date.
For Established Patients
- 98012 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves straightforward medical decision making, and/or the provider spends more than 10 minutes of total time on the encounter on a single date.
- 98013 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves low medical decision making, and/or the provider spends 20 or more minutes of total time on the encounter on a single date.
- 98014 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves moderate medical decision making, and/or the provider spends 30 or more minutes of total time on the encounter on a single date.
- 98015 – …synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. The visit involves high medical decision making, and/or the provider spends 40 or more minutes of total time on the encounter on a single date.
Note: The previous telephone-only codes (99441-99443) have been deleted and replaced by these new audio-only telemedicine codes (98008-98015). However, Medicare does not recognize these codes and will consider them invalid for billing purposes.
New CPT Code for Brief Communication (Virtual Check-in)
AMA has introduced CPT code 98016 in 2025 to report brief communication technology-based service.
- 98016 – Brief communication technology-based service (e.g. virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion.
Stay ahead of the curve with the latest CPT coding updates and maximize your pediatric practice’s revenue growth!
- Vaccines
The CPT codes for pediatric vaccines were updated in 2024; the updates are officially included in the 2025 AMA CPT Codebook. Key changes include:
- 90684 – Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use.
- 90624 – Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use
- 90695 – Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use. This code will be effective once FDA grants Emergency Use Authorization (EUA) or approval.
- 90593 – Chikungunya virus vaccine, recombinant, for intramuscular use.
Note: CPT code 90593 will follow the code 90589 and is effective since January 1st, 2025. It will be included in the 2026 AMA publication.
- Remote Therapeutic Monitoring
Remote therapeutic monitoring (RTM) codes allow pediatric providers to bill for services related to initial set-up, patient education, and delivery of medical devices. Remote monitoring in pediatrics is becoming more common, especially for chronic conditions, mental health therapy, and physical rehabilitation. However, it’s important to verify the specifics with the payer, as some plans may have different rules for pediatric remote monitoring.
These services involve devices for tracking patient data remotely. The CPT code revisions in 2025 include:
- 98975 – Remote therapeutic monitoring (e.g. therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment.
- 98976 – Remote therapeutic monitoring (e.g. therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, each 30 days.
- 98977 – Remote therapeutic monitoring (e.g. therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, each 30 days.
- 98978 – Remote therapeutic monitoring (e.g. therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, each 30 days.
Stay Ahead of CPT Updates with Outsourcing Services
The introduction of new telemedicine codes, revised vaccine administration codes, and expanded remote therapeutic monitoring services presents pediatricians and medical coders with increasingly complex coding and billing challenges. By partnering with an experienced medical coding company, pediatric practices can ensure accurate code selection, minimize the risk of claim denials, and streamline administrative workflows. Incorporating outsourcing into your practice’s strategy not only enhances operational efficiency but also maximizes profit generation. As we move into 2025, staying ahead of CPT updates through outsourcing will be essential for pediatric practices to thrive in an increasingly dynamic healthcare environment.
Also read: Key CPT Code Updates for 2025
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